Donor and recipient polygenic risk scores influence the risk of post-transplant diabetes

Abraham Shaked, Bao Li Loza, Elisabet Van Loon, Kim M. Olthoff, Weihua Guan, Pamala A. Jacobson, Andrew Zhu, Claire E. Fishman, Hui Gao, William S. Oetting, Ajay K. Israni, Giuliano Testa, James Trotter, Goran Klintmalm, Maarten Naesens, Sumeet K. Asrani, Brendan J. Keating

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Post-transplant diabetes mellitus (PTDM) reduces allograft and recipient life span. Polygenic risk scores (PRSs) show robust association with greater risk of developing type 2 diabetes (T2D). We examined the association of PTDM with T2D PRS in liver recipients (n = 1,581) and their donors (n = 1,555), and kidney recipients (n = 2,062) and their donors (n = 533). Recipient T2D PRS was associated with pre-transplant T2D and the development of PTDM. T2D PRS in liver donors, but not in kidney donors, was an independent risk factor for PTDM development. The inclusion of a combined liver donor and recipient T2D PRS significantly improved PTDM prediction compared with a model that included only clinical characteristics: the area under the curve (AUC) was 67.6% (95% confidence interval (CI) 64.1–71.1%) for the combined T2D PRS versus 62.3% (95% CI 58.8–65.8%) for the clinical characteristics model (P = 0.0001). Liver recipients in the highest quintile of combined donor and recipient T2D PRS had the greatest risk of PTDM, with an odds ratio of 3.22 (95% CI 2.07–5.00) (P = 1.92 × 10−7) compared with those in the lowest quintile. In conclusion, T2D PRS identifies transplant candidates with high risk of PTDM for which pre-emptive diabetes management and donor selection may be warranted.

Original languageEnglish (US)
Pages (from-to)999-1005
Number of pages7
JournalNature Medicine
Issue number5
StatePublished - May 2022

Bibliographical note

Funding Information:
Funding for this study was received from the Fred and Suzanne Biesecker Pediatric Liver Center at Children’s Hospital of Philadelphia (A.S.), Gift-of-Life Organ Procurement Organization (A.S.), and National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) grant no. U01AI152960-01 (A.S. and B.J.K.).

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.


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